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Towards a healthier nation

A healthy nation needs well-trained GPs and good hospitals delivering high-quality treatments. But prevention is better than cure, and these days preventive health behaviour is a government mantra. Behaviours which make illness less likely must be promoted, and the impact of illness on health and everyday functioning minimised (Wanless, 2002). A discussion paper published recently by the Prime Minister’s Strategy Unit (Halpern et al., 2004; see weblinks) highlighted personal responsibility and the need for public health behaviour change, noting:
…achievement of major policy outcomes requires greater engagement and participation from citizens – governments can’t do it alone. …improvements depend on changes in personal behaviour: for example in health, on better diet and more exercise (p.3)

A healthy nation needs well-trained GPs and good hospitals delivering
high-quality treatments. But prevention is better than cure, and these
days preventive health behaviour is a government mantra. Behaviours
which make illness less likely must be promoted, and the impact of
illness on health and everyday functioning minimised (Wanless, 2002). A
discussion paper published recently by the Prime Minister’s Strategy
Unit (Halpern et al., 2004; see weblinks) highlighted personal
responsibility and the need for public health behaviour change, noting:
…achievement of major policy outcomes requires greater engagement and
participation from citizens – governments can’t do it alone.
…improvements depend on changes in personal behaviour: for example in
health, on better diet and more exercise (p.3)
and concluding:
…behaviourally-based interventions can be significantly more
cost-effective than traditional service delivery. There is good
evidence across a range of policy areas – for example in health – of
the cost-effectiveness of behavioural interventions (for example, a
change in diet that avoids a heart attack is better and cheaper than
dealing with the consequences of poor diet with heart surgery). (p.3)
The Department of Health White Paper Choosing Health, published in the
same year (see weblinks), confirmed the central role of the application
of health psychology expertise in effecting such change.
Health psychology research locates determinants of health behaviour within
a multi-layered biopsychosocial model including biological processes
(e.g. the biochemistry of nicotine absorption), cognition (e.g.
understanding health risks), emotion (e.g. denial and avoidant coping),
interpersonal processes (e.g. interactions between healthcare
professionals and their patients), organisational and cultural effects
(e.g. normative pressures experienced by healthcare professionals in
everyday practice), and national and supranational policy frameworks
(e.g. taxation and legislation) (Smith et al., 2004). Considerable
progress has been made in understanding such processes across a variety
of behaviours (see Kaptein & Weinman, 2004; Ogden, 2004). The
challenge for health psychologists now is to demonstrate that
evidence-based interventions designed to change health behaviour are
effective in delivering health benefits at individual, community and
national levels.
In facing this challenge, health psychologists must integrate new
technology into behaviour change interventions (e.g. Smith et al.,
2004), contribute to the training and management of healthcare
professionals so that their interactions with patients have maximum
impact on patients’ health behaviour, and also work at community and
government level to influence public health policy. Significant
progress is being made: health psychologists have specific and
complementary skills to offer; they are working in government to
promote policies founded on evidence-based approaches to health
behaviour change; and the effects are being seen ‘on the ground’. The
articles in this special issue showcase this progress to illustrate how
health psychologists can contribute to building a more effective and
efficient health service.
First, Jane Wardle and Andrew Steptoe map out the differences between
psychological research into individual health behaviours and research
into public health trends, such as the rise in obesity. They urge
health psychologists to engage with public health issues and highlight
relevant approaches and methods.
In the second article, we describe work undertaken by health
psychologists in the Public Health Division of the Department of
Health. This work illustrates the role of health psychologists in
commissioning and undertaking research relevant to public health
policy, and in shaping evidence-based public health policy. The article
also reports on developments towards recognition of health psychologists as public health specialists.
The last article, by Lynn Myers and Charles Abraham, highlights
research with a long history in health psychology – the impact of
healthcare professionals’ behaviour on patients’ adherence to
treatment. Many health psychologists
work in clinical settings (whether in cardiac rehabilitation or pain
clinics) as part of multidisciplinary teams who focus not on changing
public health behaviour but on changing the behaviour of individual
patients to enhance their health and maximise the impact of treatment.
Similarly, health psychologists are involved in delivering
evidence-based training to healthcare professionals. This final article
focuses on evidence which has direct implications for how healthcare
professionals can manage consultations to maximise patient adherence.